A small number of people struggle with persistent fears that they're gay. But they're not closeted — instead, they have a form of OCD.

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Time's Jeffrey Kluger tells the story of Bethany, who struggled with the condition:

Fifth grade was the year Bethany started to notice boys — and to wonder if she was noticing them quite enough. The girls she knew were already swooning over Kirk Cameron, Michael J. Fox and other teen heartthrobs of the day. She was swooning too, she guessed, but in the same way her friends were? And what about when it came time to kiss a real boy in her own world? Would she want to?

Kluger explains that while questions like this sometimes do lead people to discover that they're gay, Bethany felt "instinctively" that she was straight. He writes, "Her anxiety grew from an increasingly common form of obsessive-compulsive disorder (OCD) in which people who may have no moral or cultural qualms about homosexuality suddenly begin despairing of the possibility of ever knowing with blood-test certainty just what their sexuality is." Bethany's instinct that she was attracted to men didn't stop her from worrying about her sexuality for 20 years, until she finally found a website that described her symptoms, and entered cognitive-behavioral therapy.

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Bethany's story and other accounts of homosexuality OCD (HOCD) are potentially controversial for lots of reasons. For one thing, some people do experience prolonged denial over their sexuality, often because they get the message from their families and from the culture at large that being gay is unacceptable. Also, so-called "reparative" therapy that claims to "cure" homosexuality is immoral and harmful — and until all too recently, homosexuality itself was erroneously classed as a mental disorder by the DSM. Understandably, this might make a lot of people leery of therapy that talks someone out of the idea of being gay.

But that's not really what Bethany's treatment did. Instead, it focused on acceptance:

Bethany overcame her obsessive-compulsive anxiety about her sexuality by first looking at pictures of sexy actresses and trying to notice feelings of actual arousal. If she thought she felt something (and after years of self-scrutiny, that was all but certain), she tried to accept — and shrug at — the questions it raised. Next she began going to movies about lesbian couples, like The Kids Are All Right, and reading magazine stories about women who discovered their homosexuality later in life — accepting the possibility that their story could be hers.

By accepting that it would be fine if she were gay, Bethany was able to quiet her fears. And when the fears were gone, she discovered she wasn't really attracted to women. Obviously accepting one's sexuality is important no matter what that sexuality turns out to be, and being gay shouldn't be something people have to worry about. But even if we were to eliminate all homophobic bullying (a goal that currently seems sadly far-off), some people with OCD might still fear being gay. Kluger writes, "Uncertainty is the fuel for OCD, and the harder a sufferer tries to answer the unanswerable, the hotter the obsessional bonfire burns" — so the feeling that they couldn't be sure about their sexual orientation might plague some OCD patients even if we lived in a non-homophobic society.

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Writing at BrainPhysics.com, Mark — who is gay and has OCD, but does not have fears about his sexuality — explains how he found out about HOCD:

Searching under OCD and gay, I discovered the old BrainPhysics discussion board and decided to post. I thought I was joining a board full of gay people with OCD. Only ten minutes after I had started reading the most recent posts, however, I realized that something was wrong: The folks with gay fears were clearly not gay. It took another five minutes for me to figure out what HOCD was and why so many people had gay obsessions. "Well, duh!" I thought. "This is an OCD board. Of course they have false obsessions."

He goes on to offer an explanation for how OCD might make someone doubt his or her sexual orientation:

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Before my own OCD was treated, I had suffered for years with obsessions about natural disasters, religion, my health, and being rejected. What I saw in the HOCD obsessions mirrored the anxiety, checking, illogical thinking, and broken record quality of everything I had experienced. HOCD felt real to its sufferers just as my own obsessions had felt real to me. Again, duh! OCD always feels real. If it did not, it would not be OCD. It plays with your mind, making you believe lies and doubt truth.

Ultimately, treating HOCD isn't about making value judgments about sexuality — or "turning" someone straight, as reparative therapy falsely claims to do. Instead, it's about helping people separate their obsessional thoughts from reality. Learning to do this can help OCD patients lead a happier life, no matter what their orientation turns out to be.